The implementation of peer support schemes for social care in adult prisons in England and Wales

Overview

What was already known:

• Peer support schemes in prisons are used internationally for a wide range of support needs.
• Peer support schemes for social care are frequently used in prisons in England and Wales.
• Models of peer support schemes may vary in their levels of formality (e.g. provision of training and support).

What this chapter adds:

• The implementation of peer support schemes for social care varies across prisons in England and Wales, demonstrating a range of different leadership models and levels of governance processes (e.g. thoroughness of employment processes, training and supervision).
• Training and supervision of buddies and staff was variable, with some schemes not having any formal training in place, and buddies not always receiving the training on offer.
• Implementing peer-supported social care is influenced by a range of factors, including service factors (e.g. resources and collaboration between organisations), prison factors (e.g. prison regime and turnover of buddies), staff factors (e.g. attitudes and awareness), prisoner factors (e.g. role desirability, need and attitudes).

Introduction

Earlier chapters have indicated that peer support services are used for a range of purposes in prisons in England and Wales, including to support with the provision of social care (see Chapters 3 and 4). Findings from the documentary analysis suggested that these services were frequently used (40.2% of prisons) and that they range in how formal they are (see Chapter 41). While guidance on implementing peer support schemes for social care exists (see Chapter 145), peer support services for social care are not mandated in prisons in England and Wales.45 Empirical studies of peer-supported social care are needed on how peer support services for social care are implemented and the factors influencing implementation.

This chapter outlines:

1. The context for prison peer support services for social care in England and Wales (type of social care needs, number of social care needs and factors influencing social care).
2. An overview of their development.
3. An analysis of how peer support schemes for social care have been implemented in 18 prisons in England and Wales.
4. An analysis of the factors that influence their implementation.
5. Stakeholder (national and local leads, and prison leads) views.

Methods

This chapter draws on findings from interviews with national and local leads, and interviews with prison leads. Where appropriate (e.g. when referring to social care support and implementation), we also include relevant analyses from staff and prisoner interviews (see Chapter 2).

Findings

Participant characteristics

This chapter draws on 71 interviews, including interviews with national and local stakeholders (n = 7), prison leads (n = 20) from 18/20 selected prisons, staff (n = 7 from 5 prisons), peers (n = 18 from 4 prisons) and recipients (n = 19 from 5 prisons) (see Report Supplementary Material 6). Findings highlighted that the majority of prisons had peer support schemes for social care (Figure 3) and that the organisation responsible for leading the peer-supported social care varies across prisons (Figure 4).

FIGURE 3 Summary of whether prisons have a peer support scheme. a, Two prisons are ‘TBC’, as those prisons were recruited to take part but then we were unable to identify participants to take part in the study, and therefore were unable to determine who leads. (Figure not reproduced here; see the original article.)

FIGURE 4 Summary of the organisation(s) leading/running peer support. a, Two prisons are ‘TBC’, as those prisons were recruited to take part but then we were unable to identify participants to take part in the study, and therefore were unable to determine who leads. (Figure not reproduced here; see the original article.)

The social care context in the 18 prisons studied

Number of people with social care needs

National stakeholders indicated that there are no centrally collected data on the number of people in prisons in England and Wales with social care needs. National stakeholders emphasised that the number of people with social care needs varies across different prisons (e.g. some prisons with a relatively high number of people with social care needs, and others with a very low number of people identified as having social care needs). Prisons with a low number of people with social care needs may be establishments where social care needs are not visible, not well understood, where there is a fast turnover of prisoners, a short-term prison or a prison with a low number of prisoners.

The number of individuals who require formal support for social care needs varied across the 18 prisons. Many prison leads reported that the number of those needing social care was difficult to quantify (see Appendix 3, Table 29). Some of the prison leads reflected on whether they felt that the number of people requiring social care support in prison has changed over time, with many of the prison leads reporting that they felt the social care needs were increasing over time, and a couple of prison leads reporting that they felt social care needs remained steady. None of the interviewees reported a decreasing need for social care.

Type of social care needs

Prison leads indicated that a wide range of groups of individuals require social care support in prison. Most prison leads highlighted the need to support older adults, and people who use a wheelchair or who need support with mobility were commonly identified as needing social care support. Other groups of individuals needing support were also identified (see Appendix 3, Table 29).

How social care is delivered in the 18 prisons

In relation to who is involved in delivering the overall social care pathway, different models were used, but most models of social care involved a partnership between the local authority and prison. When reported, findings highlight that different providers are involved at different stages of the social care pathway (see Appendix 3, Table 29), for example, the majority of assessments were done by the local authority. Half of the prisons reported what the social care assessment entailed (e.g. social care needs and equipment needed). A few prisons also focused on developing care plans and making referrals to other services. Only four of the prisons reported that their social care appointments were documented.

Factors influencing social care provision

National stakeholders and prison leads highlighted four factors that help and get in the way of social care provision in prisons in England and Wales. As peer-supported social care must be considered in the wider context of social care provision in prisons, these factors provide context for the implementation of peer-supported social care. The four factors influencing social care provision in prisons were: (1) understanding social care and the need for prison social care roles; (2) collaboration between prisons and local authorities; (3) clear processes and procedures for social care; and (4) availability of resources (see Appendix 3, Table 30).

Development of social care peer support schemes for social care in prisons in England and Wales

Other peer support services in prisons in England and Wales

National leads and prison leads highlighted that wider peer support schemes are not new in prison settings, and are commonly used across the prison estate for a range of purposes (see Chapter 3) (e.g. listeners, equalities representatives, safer custody representatives, peer support for drug and alcohol services, mental health peer workers, chaplaincy peer supporters, self-harm, learning difficulties, violence reduction, induction and healthcare representatives).

Development of social care peer support services in prisons in England and Wales

Peer support services for social care have been developed with a view to support prison estates with the provision of non-personal care, and a need to formalise any pre-existing support. They are not currently mandated in prisons in England and Wales, but instead it is up to governors to choose whether or not to adopt them. National and prison leads supported earlier findings (see Chapters 3 and 4) by outlining perceptions that most prisons in England and Wales with social care needs are likely to use a peer support scheme. The development of these services is outlined below.

Development of peer-supported social care from a national perspective

Initial action driven by need

Findings from national lead interviews indicated that prior to the introduction of the Care Act of 2014, there was a clear perceived need for peer support in prisons. Participants gave examples of how forums were developed to informally support prisoners with social care needs. Following this, in 2010, the organisation Recoop44 was funded to support informal peer support models which were driven by the vulnerability of older cohorts and issues of manipulation. Meetings took place between Recoop and a local authority to formalise peer-supported social care training to meet care standards, using the national care certificate and adapting this to fit prisons (e.g. removing the child safeguarding module and adding wheelchair use and stairlift). Lots of different organisations were involved in the development of the Recoop model, including the local authority (moderating and checking peer support standard), prison partners (adaptations to regime and pay for buddies, operational day-to-day support) and healthcare providers.

Introduction of the Care Act22 and peer-supported social care

National leads outlined how the introduction of the Care Act22 prompted the formalisation of peer-supported social care. The Care Act22 outlined that peers could be employed to support with social care needs to free up staff. Participants felt that the peer support model needed boundaries due to there being no policy position, and potential for risks including blurred boundaries resulting in delivery of personal care (e.g. washing and dressing), risks of exploitation and safeguarding issues.

Formalisation of Recoop model of peer support

On publication of the Care Act, the Recoop model was formalised in collaboration with commissioners, health authorities, the Ministry of Justice, and peer providers. Participants recalled how the training for the Recoop model of peer support was ready once the Care Act was published. This model was further developed in line with legislative changes. In this model, buddies are trained, vetted and screened, and Recoop provides training to buddies, in addition to follow-up support, for example one-to-one support.

Introduction of HMPPS policies

The enactment of the Care Act from 2015 onwards triggered the publication of three policies (PSIs): (1) adult social care;26 (2) adult safeguarding46 and (3) prisoners assisting other prisoners45 (see Chapter 1). National leads highlighted that the PSI for prisoners assisting other prisoners details the boundaries for social care peer support, and the need for risk assessments, appropriate selection, boundaries, payment and supervision. As mentioned previously, peer support is encouraged by HMPPS but not mandated.

Local adaptation of peer support model

National leads highlighted that while Recoop was funded to produce guidance for all prisons, some local authorities or prisons adapted the service in line with their own services (e.g. using the Recoop model as an example to replicate in terms of governance, training and support), and some prisons and local authorities produced their own version completely. This has led to different types of peer support being implemented across England and Wales.

Local development of the schemes across the 18 prisons

When asked about the development of peer support schemes for social care in their establishment, many prison leads reported that the scheme was already in place before they started working at the prison and that they did not know how their service developed. Different types of development processes were highlighted in the interviews (Box 2).

Prisoner-led and needs driven (n = 2): Where the service began as an informal peer support scheme led by prisoners (where prisoners helped other prisoners as they recognised a need for support), and then this was replaced by a formal governed peer support scheme.

Driven by local authority (n = 3): Some services were developed by the local authority and implemented in local prisons.

Driven by external company and then in-house (n = 3): When the service started 10 years ago, they had an external company managing the programme initially. One prison highlighted that, due to funding issues, they had to manage the service and just commission the external company to train buddies. Other prisons highlighted that due to funding, they brought the scheme in-house and developed and delivered their own training package.

Service still in development (n = 3): Some prison leads highlighted that a prison-led scheme was in place before COVID-19 but that it slipped during COVID-19 and is now running as a pilot scheme in development. Other prison leads highlighted that they were in the process of developing their recruitment, training and governance processes. One prison highlighted trying to secure funding to train people as buddies but that it was difficult to justify due to low need.

Not known how service developed as already in place (n = 5) or not reported (n = 1).

Plans to develop in future (n = 1): Some prisons do not yet have a formal support but want to develop one.

Aims, goals, outcomes and perceived impacts of services

Participants (national leads and prison leads) highlighted a number of aims/goals and outcomes/perceived impacts of services (see Appendix 4, Table 31) at four levels: recipients; peer supporters; prison staff and prison environment. Some prisons had a clear focus on improving independence and reducing support, whereas other prisons had a task-focused approach whereby the buddies supported prisoners by completing tasks.

Implementation of social care peer support schemes in prisons in England and Wales

How services are implemented

Different models of social care peer support were implemented across the 18 prisons included in the study (Table 6).

Seventeen of the prisons have implemented peer-supported social care, with most prisons having a formal peer support scheme (n = 15), one having both informal and formal peer support and one having informal peer support. Only one prison reported not including any type of peer-supported social care due to a perceived lack of social care need. Peer support schemes use different names for peer supporters, including buddies, carers, carers/buddies, care and support orderlies, and domestics.

The support provided by buddies complements the support provided by professional social care staff in the prison. While professional staff provide personal social care, all prison leads highlighted that buddies provide non-personal social care, including domestic tasks (such as collecting meals, cleaning cells, laundry, transport, welfare checks, supporting with visits, and supporting to collect medication) and communication tasks (e.g. providing company). However, four sites did report that buddies may help with putting on certain items of clothing such as jackets.

Leadership models

Across the 17 prisons that have a peer support service, we identified different models involved in leading and governing peer-supported social care schemes. These included models where one organisation took responsibility, for example prison staff leading and governing (n = 10), the local authority leading and governing (n = 2), and also models where more than one organisation took responsibility, for example local authority and prison (n = 4), or the prison and an external organisation (n = 1).

Workforce

Many staff members from the local authority, prison, private social care providers and external organisations are involved in supporting and delivering the peer support scheme across the different prisons. The most frequently reported staff members involved in peer support schemes across the prisons were prison wing staff (n = 12 prisons), prison safer custody team (n = 10), local authority social care team (n = 8), prison equalities team (n = 6) and prison health care (n = 6).

Size of peer support scheme

Findings highlighted that the number of buddies recruited to provide social care support and the number of recipients of peer-supported social care differs across prisons (see Table 6).

Governance processes

Recruitment and employment

In terms of recruitment and employment, prison lead findings highlighted that most (but not all) of the schemes have an application process (n = 13) or vetting process (n = 14). Case study findings highlighted that application processes differed across and within sites. Application processes in the case study sites included: prospective buddies filling in application forms; responding to poster advertisements; asking staff if they could become buddies; and being asked by staff if they could become buddies.

However, only some of the prisons reported interviewing potential buddies (n = 7) or provided buddies with contracts or job descriptions (n = 10).

In terms of payment, most of the prisons pay their buddies with money to provide social care support as part of their prison employment (n = 15). Case study findings illustrated this further by demonstrating that pay varied greatly across the four case study sites with peer support schemes (range: £5–35). The prison that paid buddies the most was a private prison, and the prison that paid prisoners the least was a women’s prison. Buddies when interviewed highlighted that while they are paid for the role, they are not always paid for all of the shifts they work (e.g. that in reality it is a 7-day role, but buddies are paid only for 5/6 days).

Training and support

Six of the prisons did not have any formal training and support in place for buddies. Only 10 of the 17 prisons with peer support social care services reported providing buddies with formal training. Of the 10 prisons that provide formal training, those delivering the training differed across prisons and ranged from local authority staff (n = 5), an external organisation (n = 2), prison and external organisations for specific topics (n = 2) and the prison (n = 1).

The topics covered during training in these 10 prisons ranged from targeted training sessions on one or more specific topics (n = 3) (e.g. mental health, dementia, cell cleaning ‒ including accredited formal cleaning such as blood spills ‒ well-being, awareness, wheelchair pushing), through to thorough module training packages which included a range of topics (n = 7). The module training packages tended to be delivered in localities where the local authorities and/or an external organisation were involved. For example, the training package delivered in prisons by one local authority included the Care Act, the buddies’ role (what they can and cannot do), safeguarding, what to do if issues arise, capacity, boundaries, and confidentiality.

It is important to note that even where training exists, buddies do not always receive this training in practice. For example, in one of the case study sites, buddies reported that some of them had received a formal module training package from the external organisation but that others were still waiting to receive this training (despite having been doing the role for a long time). Additionally, training may not be standardised, with buddies receiving different amounts of training in one site (from couple of hours to 2 weeks). Some of the buddies reported having been trained in cleaning, wheelchair training, and dementia training, but not all buddies receive this training, as buddies emphasised the additional training that they needed included dementia training, biohazard training, wheelchair training, manual handling and training on the rules of being a buddy and how to do it.

Buddies from two of the case study sites (one of which reported no formal training and one which delivered specific courses) reported having the opportunity to shadow other buddies and emphasised the importance of shadowing and on-the-job training to learn from other buddies.

Thirteen of the prison leads reported that support and supervision was provided to their buddies. Findings from the case study sites support this finding but demonstrate how support varies across sites, with some buddies in some sites reporting receiving monthly group supervision and/or one-to-one support as required, and others receiving more ad hoc support from each other and other sources in the prison.

Only seven of the prison leads reported that staff received training for topics related to social care. Training for staff was also infrequently discussed in the staff, peer and recipient case study interviews. The staff that did discuss training highlighted that they received the usual staff training but nothing formal or additional in relation to social care and supporting the peer supporters.

Summary of models implemented

Governance processes for peer support models include employment processes (application, vetting, interviews and contracts), payment, training and supervision for buddies, and training for staff. We have developed a taxonomy of peer support governance models that are implemented across the 18 services (Table 7).

Various models were implemented in practice (see Table 7). However, it is important to note that none of the services had clear and formalised processes in place for all stages (including application, vetting, interviews and contracts), in addition to training and support for buddies and staff (see Table 7).

The sites that had the most robust processes (model 2) were led by both local authority and prison teams or local authorities. These prisons varied in terms of characteristics (male vs. female, public vs. private) but tended to be higher security prisons (category A long-term, high-security/category B and closed conditions).

Sites reported variations in the types of employment processes used and the amount of training and support for buddies (models 3–5). The peer support schemes in these prisons varied in terms of who leads the peer support scheme (prison vs. local authority vs. prison/external organisation), and characteristics (male vs. female) and tended to be either category B or C prisons, with the exception of one closed condition prison.

Some prisons reported no formalised employment processes and limited training and support for buddies and staff (model 6). These prisons were all adult male establishments and tended to be lower-security prisons [e.g. category D (open prisons), or a mixture of B/C/D, with the exception of one category B prison].

Monitoring and evaluation of schemes

When asked about how they monitored and evaluated peer support schemes for social care, interviewees highlighted a lack of formal monitoring and evaluation approaches in most cases (see Chapters 8 and 10).

Factors influencing implementation

As outlined above, we have identified key differences in the models of peer-supported social care in prisons in England and Wales. Interviewees (national stakeholders and prison leads) outlined many factors which influence implementation of peer support social care schemes in prisons in England and Wales, including service factors, prison factors, staff characteristics, prisoner characteristics and societal factors (Figure 5 and see Appendix 4, Table 32).

FIGURE 5 A visual summary of the barriers and facilitators influencing the implementation of peer-supported social care. (Figure not reproduced here; see the original article.)

Social care peer support service factors

Resources were found to be a key barrier and facilitator. Prison leads highlighted that staffing and resources prevents the implementation of peer support services for social care (e.g. not having dedicated individuals to support the scheme). On the other hand, having sufficient resources and staff members who take responsibility to run and lead the peer support scheme facilitates the implementation of peer support schemes for social care. This finding relates to the previously highlighted finding surrounding social care being an add on role in many prisons, thus resulting in prison staff not having time to dedicate to social care, and by extension potentially peer-supported social care schemes.

I would like them to be on the detail regularly without being counted down to do other work. I appreciate the prison service is in a crisis with staffing shortages, but we do need the social care.

Secondly, collaboration between organisations (e.g. prisons and local authorities, and prisons and external organisations) was important, facilitating peer-supported social care. Local authority involvement was found to be important in a range of contexts, including having ownership over peer support, providing professional input on the need of social care support and supporting training. However, earlier findings highlighted that only a minority of prisons have processes in place for local authorities and prisons to work together to implement peer support schemes for social care, and some prisons had struggled in forming these successful relationships with local authority partners.

Finally, training and supervision processes for staff and buddies were perceived to facilitate implementation of peer support services for social care (even in places without training currently).

Prison factors

Prison leads reported that prison regime was a key barrier to implementation of peer support schemes, due to it not being possible to unlock buddies to provide support in cases where the prison or wing is on lockdown, incidents have occurred, or the prison is short-staffed.

To me prison it’s like a microcosmic system in itself which has lots of bureaucratic elements to it around control and around a regime, around a way of doing things and I think that’s very much embedded in prison and I think the difficulty is challenging that.

National and prison leads highlighted that the type of prison (category, amount of social care need, male/female) influences whether or not peer-supported social care is implemented. For example, prisons with high levels of social care need were thought to be good environments for peer support, whereas other types of prisons (e.g. open prisons) were thought to be less appropriate. Having a high turnover of prisoners trained to provide support (e.g. prisoners being released from prison or transferred to a different prison) created difficulties as it leaves the prison with too few buddies trained to provide social care support (e.g. in busy local prisons), thus undermining the reliability with which schemes can be provided.

Having structured approaches for peer support social care schemes supports implementation (e.g. having a compact for buddies, having a standardised way of evaluating the peer support schemes, having employment and training procedures and having clear boundaries). Yet many prison leads reported that these standardised processes were not yet in place in their establishments.

Staff characteristics

Barriers relating to staff characteristics centred mainly around attitudes and awareness. Negative staff attitudes such as a lack of acceptance towards prisoners, trained buddies, social care, or peer support schemes was a barrier to implementation.

There are some very good officers and some good staff who are really suited to the role. There are some who don’t feel that we should be putting this social care in and it’s part of their punishment [ … ] the kind of sympathy from a lot of officers just isn’t there at all.

Additionally, a lack of awareness surrounding social care, the role of peer supporters for social care and a need for the scheme limits implementation.

Facilitators included having project champions who understood the need and wanted to ensure the success of peer support schemes for social care. This, together with wider staff buy-in and support for the scheme, and awareness of the scheme, facilitated their implementation.

Prisoner characteristics

Desirability and value of social care peer support was identified as both a barrier and facilitator. We identified differences in prison lead perceptions of the desirability of the role among prisoners. Some prison leads highlighted that this role is an unloved role (e.g. due to lack of transferability of skills into the community for prisoners who are in category D prisons, lack of pay, lack of recognition and value, and identifying those who want to do the role and who are appropriate to undertake the role), whereas other prison leads discussed how the role is desirable in their community.

It’s not a role we can force somebody to do. [ … ] We haven’t got many people that want to do it, that don’t also overlap into that category of risk in terms of the offences they’ve committed.

It’s always been a popular role for prisoners because it used to be one of the highest paid ones.

The second factor influencing implementation is the perceived need for peer support in each prison community. Many prison leads highlighted that there is a lack of need for buddies to support other prisoners with social care in their community, due to the status of the prison (e.g. remand prison), or the needs of their prisoner populations. Therefore, social care peer support schemes may not be perceived to be appropriate in all environments. This finding was also supported by national interviewees who highlighted variation in number of needs across different prison settings.

Yes, so in prisons, where you’ve got an older population, you see them more geared towards it. [ … ] some places have got none [ … ] and some of them will have- they’ll say, they haven’t got any social care needs, which is always a little bit more worrying.

Finally, some prison leads highlighted barriers surrounding prisoner attitudes to peer support schemes, for example certain groups that are harder to engage, prisoners reluctant to access care from buddies, and buddies reporting being taken advantage of in the past.

Societal factors

Societal factors were infrequently reported by prison leads, but a couple of interviewees highlighted that COVID-19 was a barrier to implementing peer support schemes, as prisoners were locked in their cells for a large amount of time to prevent spread of infection. One prison lead highlighted that external momentum due to population changes (e.g. increasing older population) facilitated the implementation of social care peer support schemes.

Stakeholders’ views of peer support schemes

Generally, prison leads reported positive views of peer-supported social care, emphasising that buddies do a difficult but good job. Throughout the interviews, it was emphasised that buddies providing non-personal social care is appropriate but that the role should not ever be used to provide personal care to other prisoners. National and prison lead views are outlined in Chapter 7.

Discussion

Key findings

Peer support services for social care have been developed and implemented in prisons in England and Wales to formalise informal support provided by prisoners and in response to the Care Act22 and perceived rising social care needs. Most prisons have implemented formal peer support schemes for social care to support prisoners with non-personal social care tasks such as cleaning cells, collecting food and moving about the prison, and potentially improve outcomes for the prison, staff, recipients and buddies. The implementation of peer support schemes for social care varies across prisons in England and Wales, demonstrating a range of different leadership models (e.g. prison-led, local authority- and prison-led, prison-led, local authority-led and external organisation-led), and governance processes (thoroughness of employment processes and training and supervision). While there were some examples of good practice identified (e.g. formal application processes, or formal training and support processes identified in specific case study examples), none of the prisons had clear processes in place for buddies for all aspects of employment and training (buddies and staff), and some prisons did not report any formal training mechanisms for buddies. Even when prisons had training processes in place, findings indicated that this training was not always received in practice. Prison leads and national stakeholders outlined a range of factors influencing the implementation of peer-supported social care, including service factors (e.g. resources and collaboration between organisations), prison factors (e.g. prison regime and turnover of buddies), staff factors (e.g. attitudes and awareness), prisoner factors (e.g. role desirability, need and attitudes).

How findings relate to previous research

Previous research highlighted that there are high levels of social care needs in prison populations, but that needs are often unmet7,30–34 and that social care provision varies across different prisons1,16,35 (see Chapter 4). Findings extend previous knowledge by providing empirical evidence on national stakeholder and prison lead perspectives on social care provision in prisons in England and Wales, including how these are implemented and the factors influencing social care delivery. Findings extend previous research by outlining the key factors influencing social care provision (dedicated roles, collaboration, processes/procedures and resources). Findings highlight that prisons and local authorities may not always have collaborative working relationships and thus working together to provide social care and peer-supported social care may be challenging. This contradicts the PSI on adult social care, which indicates that all local authorities should have a responsibility to work with prisons to meet social care needs and develop care plans.26

While previous findings outlined the existence and variation of peer-supported social care1,16,35 (see Chapter 4), little was known about the development of peer support services for social care and how they have been implemented in practice. Findings extend previous research by highlighting that peer support services vary in practice, across a range of different domains. Most formal peer support services are led by prisons, with only a few models being led collaboratively by local authorities and prisons or external providers and prisons.

Findings indicated that not all prisons have a formalised peer support scheme in place for social care, due to a lack of current need in their establishment. While some examples of clear recruitment, employment, training and support exist in some prisons, many prisons do not yet have these processes in place and none of the prisons we spoke to robustly has all of these procedures in place, despite recommendations for peer support workers to have clear roles, training and supervision.5,16 This finding supports findings from Chapter 4 which indicated that peer support schemes for social care, as reported in HMIP reports, varied from informal unsupervised peer support through to buddy schemes with robust training processes.1 Together, findings refute the PSI which emphasises the need for buddies to be appropriately selected, risk assessed, trained, supported, and supervised to safeguard buddies and recipients.45 Findings also indicate that despite guidance suggesting that all prison peer support for adult social care schemes should have clear governance processes,45 these are not yet in place across all prisons (though there are some examples of good practice). Furthermore, the PSI emphasises that buddies must not provide intimate care, and instead must provide non-personal care social care tasks such as cleaning cells (see Chapter 145). Findings support this and indicate that staff report that buddies are mostly providing appropriate levels of non-personal care in prisons in England and Wales (for buddy/recipient views see Chapters 6 and 7).

While the size of peer support scheme (in terms of approximate number of buddies and recipients) varies (see Table 6), the numbers of people receiving peer support currently (in the prisons studied) were relatively small. The study provides an insight into the potential factors that may have influenced the varied implementation of peer support schemes in England and Wales.

Strengths and limitations

This chapter triangulates findings from prison leads (across 18 prisons) and national leads (across a range of roles). This helps to build a comprehensive view on the context and implementation of peer support schemes for social care in prisons in England and Wales.

We selected a purposive sample of prisons, based on a range of characteristics. However, not all prisons in England and Wales were included in this study, so the findings may not generalise to all models of peer-supported social care. This approach is complementary to the approach taken in Chapter 4 where we reviewed HMIP reports for the majority of prisons in England and Wales.

As we interviewed only one or two prison leads for each prison, it is possible that we may not have all the relevant information for that establishment. However, the case study (reported in the next chapter) provides further detail on five of the models.

Implications

Prior to this study, there was little known about the factors influencing the implementation of peer support schemes for social care in prisons. These findings can be used to improve such services. From this chapter, we have derived the following implications:

While many prison leads highlighted the importance of peer-supported social care to help address increasing social care needs in their establishment, some prisons may not yet see the value in implementing these schemes, for example due to perceived low numbers of people with social care needs in certain types of prisons. Awareness raising of the need for peer support services for social care in these establishments may be necessary.

Implementing social care peer support services takes time and resources. There is a need for dedicated roles to drive, manage, and support the peer support social care scheme and protected time for staff members. These positions should have clear roles and responsibilities to ensure that social care is not overlooked and that there are adequate resources to manage and lead peer support services for social care.

Collaborations between organisations (e.g. prisons and local authorities or prisons, and local authorities and external organisations) are key for delivering social care and managing peer support social care schemes.

There is a need to formalise peer support, therefore schemes require governance, monitoring, training and supervision processes. Findings indicated that the most formal application, employment and training processes for buddies tended to be those led by the local authority or external provider organisations, so resources and support need to be in place for other prisons to achieve this.

Additionally, findings highlighted some additional barriers that need to be overcome to support the implementation of peer support schemes for social care (including overcoming issues relating to prison regime and access restrictions so that buddies can fulfil their roles), training and raising awareness among prison staff to the importance and need of social care buddies, the need to ensure that the social care peer role is valued and desirable (taking into account the responsibility and the burden that the role may entail), and collaboration across prison departments.

Future research

Future research should aim to explore the implementation of a wider sample of peer support schemes for social care in prisons in England and Wales (including prisons that are new to adopting these models).

Conclusions

Peer support schemes for social care seem to play an important and valued role in social care provision in prisons in England and Wales. However, peer support schemes have been implemented in different ways, with different leadership models, and varied levels of robustness in terms of selection, employment and training processes. Findings highlighted many factors that influence implementation of peer support schemes in England and Wales.